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Permittee Name: <br />Permit No: <br />Operation Name: <br />Ann1ver',ary Date: <br />-rota l : <br />Notice of Intent to Continue Mining Upel: iti , irl> <br />112 Annual Report <br />a. Permitted acreage: (DS• SZ <br />g`'°c "k - 4 <br />M -A7 -074 <br />Dotsero Quarry* <br />10/09/4 2 <br />1 1 79 ,ot) (Due on your Anniversary Date) <br />©.5 <br />,l. 13ackf i l led: <br />b. Graded: 0-q" <br />c Seeded: <br />List species seeded & seeding <br />rate for report year on back <br />Contact Name: _. / eriTh 64 <br />Company: , M�4 )(WO- )3' 4- 574541 <br />Addre .;: P D. RbK s "" <br />po Let LD , Go g!oc5Z_ <br />Federal Tax ID No. or Social Security No.: <br />67 sue co 44 prit.sy <br />b. County where mine is located: ' <br />2. Has this (nine been granted TEMPORARY CESSATION STATUS? <br />Does this (nine operate MORE or LESS than 180 days I,el yeah' <br />3. Does this mine have a phased reclamation plan? <br />4.• rota] acres affected during the report year:* <br />Total acres rerlaimed for the report year:* <br />6. Total acres in various 'Mayes of reclamation:* <br />d. topsoil replaced: <br />Phone <br />ataliftelao <br />YES <br />(MORE <br />Averaye topsoil tO s <br />replaced: . Nf14 <br />NO <br />L IS <br />7 The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* pope- <br />8. Estimat - ed total aches to be affected in the next report year:* 1 4 16 •. 5 ■ <br />CUMMLNIS: I / 0 \MVO in 02 -I& /Ma- L /L- iso V4J <br />* Please show the location of the acreage for items 4 - 6 on your neap * *. <br />Indicate the phases of the reclamation which have been completed, correlated with <br />your timetable. <br />O * * u I t there have nut been any changes since the I a', t cir nua 1 i ep0i t alrU yC U <br />previously submitted a map which correctly depicts the current ,idl eci le In item', 2 <br />through 6 then a new Wrap is unnecessary. However, you mu,t state tht, fact above. <br />Signature: Dare: # �.. 512-oil <br />Please type or print current contact name, mailing add e', ;, and blion e number bL'10w: <br />7i7 01-8Z78 <br />